Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition SVT treatment involves vagal manoeuvres, pharmacological or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines when vagal manoeuvres have proven ineffective. ERC and AHA guidelines recommend the intravenous route of administration. Intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year old child with SVT which was converted to NSR following IO administration of adenosine. Successful conversion was achieved in the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT.

Purpose To compare and adjust activated clotting time (ACT) between two systems and to optimize ACT during atrial fibrillation (AF) ablation. Methods Electromagnetic detection using a rotation tube (EM system; Hemochron Response, Soma Tech Intl, Bloomfield, CT, USA) and photo-optical detection using a cartridge immersed in blood (PO system; ACT CA-300TM, APEL) were compared. Results The EM system showed an ACT of 320 ± 44 s (average ± 1 standard deviation), with a range of 156–487 s, from 3363 measurements in 1161 patients during uncomplicated procedures. An ACT >400 s was observed in 3.7% (124/3364) of patients. The pre-ablation ACT measured by the EM method was 143 ± 28 s. Cardiac tamponade was observed in 4/2085 ablations (0.19%) over 5 years. The ACT associated with cardiac tamponade ranged from 330 to 391 in the EM system. The regression equation was ACT-EM system = 1.19 × ACT-PO system + 9.03 (p

Synchronous electrical cardioversion is a relatively common procedure in the emergency department (ED), often performed for unstable supraventricular tachycardia (SVT) or unstable ventricular tachycardia (VT). However, it is also used for stable cases resistant to drug therapy, which carry a risk of deterioration. In addition to the inherent risks linked with procedural sedation, there is a possibility of malignant arrhythmias or bradycardia, which could potentially result in cardiac arrest following this procedure. Here, we present a case of complete heart block unresponsive to transcutaneous pacing and positive inotropic and chronotropic drugs for 90 minutes, resulting in multiple cardiac arrests. The repositioning of the transcutaneous cardio-stimulation electrodes, one of them placed in the left latero-sternal position and the other at the level of the apex, led to immediate stabilization of the patient. Extubation of the patient was performed the following day, while full recovery and discharge within 7 days, after insertion of a permanent pacemaker.